Provider Demographics
NPI:1861943201
Name:MITCHELL, GLADYS MARIE
Entity type:Individual
Prefix:MRS
First Name:GLADYS
Middle Name:MARIE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 BEACON BLVD
Mailing Address - Street 2:
Mailing Address - City:W SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-3467
Mailing Address - Country:US
Mailing Address - Phone:916-462-3100
Mailing Address - Fax:
Practice Address - Street 1:3050 BEACON BLVD
Practice Address - Street 2:
Practice Address - City:W SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-3467
Practice Address - Country:US
Practice Address - Phone:916-462-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-20
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW1200761041C0700X
101YM0800X, 172V00000X
CAMPSS-NWRBHU175T00000X
CA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172V00000XOther Service ProvidersCommunity Health Worker
No175T00000XOther Service ProvidersPeer Specialist